by Walter Trkla
(Swans - November 4, 2013) I have lived in Canada most of my life, and I am a passionate advocate of our system of universal health care. I think our type of system was established because most Canadians see "health-care-for-all" as a human right rather than a privilege for some with economic clout and political connections. One thing that never concerned me, until now, has been the cost of affordable health care for me, my family, and all Canadians unfortunate to get sick. Our health care is not perfect but it is envied world over by many nations.
My family, like most, has had numerous health issues over the years requiring medical care. One of my daughters was born with tachycardia that eventually required nerve ablation inside her heart to fix the problem. Since her marriage, she has had three children in our local hospital -- two by cesarean section that required prolonged hospital stay and care where her medical expenses were fully covered.
I have had many knee surgeries due to sports injuries, and eventually two knee replacements that required hospitalization and physiotherapy. My wife and our younger daughter also have had health issues over their lives that required various medical services and sometimes hospital care.
If I had lived in the USA, a country that views health care as a privilege for some, and wasn't fortunate enough to work in a profession that offered top-quality health care as a benefit, I would have faced substantial medical bills, which I may not have been able to pay. Today in the USA, the single most common reason for personal bankruptcy is the cost of medical bills billed directly to the patient. That's unheard of in Canada.
In Canada, health care financing can be through the payment of premiums (as in British Columbia and Ontario), or a combination of taxes and provincial revenues, or by a combination of methods including some privately paid for treatment. The Canada Health Act mandates that all services that "are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness, or disability; and medically required physician services rendered by medical practitioners" must be provided regardless of one's ability to pay any fees associated with the service.
For the most part, my health care costs were paid for by a single payer, the Canadian government. This single-payer system creates economies of scale, and purchasing power that allows the government to control health costs. In my case and many others in BC, the monthly premium was a negotiated benefit paid by my employer.
Health care for me and my family is free at the point of use and delivered by a private provider, a doctor of my choice. Like myself, every Canadian from birth is similarly protected from exorbitant health care bills. Regardless of one's ability to pay, Canadians cannot be denied coverage for medically necessary hospital and physician services. Some provinces fund many other servicers for children, seniors, and the poor. These services may include prescription drugs, dental, ambulance, and the like.
It seems that in the USA, conservatives view health care as profit for some, rather than an essential protection for all, because nothing else can be passed through Congress. It's startling to most Canadians to listen to the opinions and thoughts of some US politicians commenting on Canadian health care in interviews, on talk shows, or via debates in American media.
Some, in the US Media circuit, comment that Canadian health care is not perfect, and they also say it is envied by many Americans. Others state that the Canadian system is financially broke, Canadians are overtaxed due to their healthcare costs, there is no individual choice in choosing doctors (the government decides who treats the sick), the wait lists are too long, many Canadians go to the U.S. to get quality care, hospital beds are not available, or Canadian doctors are fleeing the country, and many other such fabrications, too long and ludicrous to list.
My favorite inaccuracy was the concept of Death Panels or Committees that decide who would be given "total" treatment and who would be allowed to die. Sarah Palin felt it necessary to criticize Canadian healthcare, even though she used it numerous times while living in Alaska, so she must have believed it provided quality care.
Money (big, corporate money) controls US politics, and it's impossible to get elected without it. Thus, there is no shortage of politicians willing to "badmouth" Canadian health care, while at the same time promoting corporate control of health care for profit in America. Maybe the difference and reality is evident in this comment from an ordinary US citizen. A friend on vacation in Oregon, while chatting with a grocery clerk, identified herself as Canadian and said to the clerk that Oregonians were fortunate to have zero sales tax. The clerk replied..."No, you're the lucky one...you've got health care."
There is readily available statistical information which shows that American health care, by far, is the most expensive in the world, but doesn't deliver better outcomes, as compared to many other developed countries, for all of its citizens. Prior to the Obama initiative on health care, countless millions Americans had no or extremely limited insured health care at their disposal.
Even though the U.S. spends almost twice as much on health care per capita as Canada, and health care costs as a percentage of GDP are 6% higher, on average, than in Canada, Americans are poorly served by their huge financial outlay. In comparison to Canada, life expectancy in the U.S. is lower while infant mortality is almost double the rate that in Canada.
Overall, the G20 countries that have the smallest private component deliver the best health care. It's clear that the main culprit contributing to future unsustainable health care in both Canada and America is privatization. Obamacare hoped to change this, but that was not allowed because of corporate influence and power of the health industry over the political decision makers.
Obamacare is in no way similar to how my family and I are protected from exorbitant bills by the health providers. Obamacare is an insurance system that protects (to some degree) low-income people, while in Canada every citizen is automatically enrolled in the same provincial health plan, which is financed by provincial and federal taxes plus medical services premiums. Essentially, everyone is entitled to the same level of care regardless of income, wealth, or occupation.
Obamacare is not a government program or a single payer program, it is an insurance program that varies from state-to-state. In some limited cases provinces in Canada may provide services not available in every jurisdiction, but the program is transferable from province-to-province and the differences are minute in costs to the consumer.
Access to Obamacare depends on the type of insurance one subscribes to, while in Canada access depends on priority determined by one's health issues. I have had two knee replacements, which were done when it was convenient for me.
Health care that is considered one of the best in the world is provided in social-democrat Sweden. It underspends but outperforms Canada, overall. In Sweden, child mortality is half ours, life expectancy is the same as ours, the number of doctors and nurses per 1,000 is higher than ours, per capita expenditure on health is lower than ours, health cost as percentage of GDP is lower than ours, and their government revenue spent on health care is lower than ours. Significantly, their percentage of health costs paid by government is higher than Canada's. The difference between the two national health care systems is the private component in health care financing, which is 33% higher in Canada. In Sweden, the private expenditure on health care is 18.3%, while in Canada it is 30.2%.
The other interesting new development in Sweden that has caught Canada's attention is private, for-profit clinics that compete with government clinics for patients. The price for service is the same in public and private clinics, but the private clinic must be accredited by the government to provide the service. If you are a private clinic and not accredited the patient pays all the fees.
This is not competition or an apples-to-apples basis since the private and public provider does not compete on price, and product, just on distribution, promotion and speed of service delivery. This really cannot be defined as market competition since there is no price variation, and the government regulates everything from the get go in the private and public clinics. This combination of private service (25% are private clinics) and public ones has had some very positive cost saving outcomes.
The Canadian health care system has deteriorated over the past 20 years due to creeping privatization in the form of closure of government-run senior care facilities, the introduction of private, for-profit senior care, combined with some hospital closures, and the privatization of services like billing, food, construction, laundry, and maintenance. That's the main factor driving health care costs potentially beyond sustainability in Canada.
According to Nik Nanos, president and CEO of Nanos Research, 90 percent of Canadians want public, not private, answers to health care issues. OECD nations have a smaller resource base, larger aging population, they spend more on public, and less on private health care than Canada, and yet, they provide better health care than Canada. Why?
Dr. Evans, a world renowned health care economist from the University of British Columbia, writes that public spending on health care, hospital, and doctor services remains stable at four per cent to five per cent of our GDP, which is about the same amount as it was 20 years ago. The unsustainable element in health care in Canada is driven by private, for-profit services such as infrastructure costs, which are up 14 per cent, and "pharmaceuticals, for-profit diagnostic tests, dental and other non-insured services. For example, private drug plan costs are rising 15 per cent a year."
Dr. Evans writes that private corporations who claim that they can provide health care cheaper than the public system are lying to us. He also is critical of the distortion that an aging population makes public health care unsustainable. Aging, he writes, contributes 0.8 percent per year to the cost while one per cent is due to population growth, which is higher. He notes that the public system is under attack by uncontrolled private expenditures, personal and corporate tax cuts, user fee increases, and a drop in transfer payment that has led to "capping the growth of health spending to three percent [GDP] instead of six percent in the past."
The USA, prior to Obamacare, had the highest private expenditure in health care in the world, 54.6%. The countries with the highest levels of private expenditure on health care have the worst health care outcomes. Of the G20 industrial nations, as noted by Grace Rubenstein (2013) in The Atlantic, "Americans' health is even worse than we thought, ranking below 16 other developed nations."
Karen S. Palmer, a Canadian by birth, and a board member of California Physicians Alliance writes, "free-market enthusiasts, and we have them too, are very persuasive and seem to be determined that the capitalist class should be free to opt-out of contributing to a public system based on progressive taxation. Their strategy is to break the social solidarity that currently exists in the country by demanding tax cuts, thereby underfunding the public system and convincing people that we need two-tier medicine." Like some Americans, the Canadian "Right" is afraid of a good example if it comes from a socialist political system and country because it is threatening to their ability to influence the distribution of wealth.
Health care and its success in Canadian and American society is about our political will to make non-partisan collective choices where our human values do not triage the treatment of sick people by profit and their ability to pay.
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About the Author
Walter Trkla is a retired high school teacher of world history, law, and economics. He holds a master's degree in teaching. He also taught geography at Thompson Rivers University, and supervised student teachers for the University of British Columbia. Mr. Trkla was adopted by his uncle after his father was killed in WWII. He lives in Kamloops, BC, Canada, with his wife Judy. They have two daughters. (back)